Table of Contents

Volume 2, Issue 1                                                                                        January, 2016

Clinical Files

ADHD:  A Clinician’s Concern

Manuel Mota-Castillo, MD

Chief Medical Officer, Mesilla Valley Hospital; Chairman of Psychiatry, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico   

On January 4th of 2016 the National Public Radio website reported the findings of a renowned pediatrician from the Center for Child Health, Behavior and Development at Children's Hospital in Seattle. Dr. Dimitri Christakis stated that “we should be thinking more about a spectrum of "attentional capacity" that varies from individual to individual and situation to situation”. He presents this suggestion as a better alternative to the current practice of diagnosing ADHD by looking at list of behaviors and if a child presents with 6 of them the label is attached without ruling other diagnoses that also present with poor attention span and restlessness.

Dr. Christakis’ perspective got my attention because it seems to be close to the PL November 2015 special article which presents a new interpretation of the set of symptoms that we currently call ADHD. For that I commend the pediatric researcher but I think that he fell short of presenting the real picture of what is going on in the psychiatric arena regarding ADHD: thousands if not millions of children, their relatives and classroom peers are hurt by the worsening of the patient’ symptoms when they take ADHD medications because their real diagnoses (OCD, PTSD, Social Anxiety Disorder, Bipolar Spectrum Disorders, etc.) are exacerbated by amphetamine-like drugs.

I have heard Ivy League professors of psychiatry and neurology proclaim that in their practice they have dozen of autistic children “that also have ADHD and social anxiety disorder”.  Another famous psychiatrist presented at the 2014 APA Annual Meeting a collection of cases of “comorbid” ADHD and Oppositional-Defiant Disorder (ODD) which sounded like anything else but ADHD. In fact, that renowned professor lost his cool when I asked if he would consider the possibility that maybe the subjects of the study could have different diagnoses because what DSM calls ODD is not a real diagnosis but a symptom of other conditions.

Sadly, clinicians around the world believe in many scientific fallacies and prescribe the most powerful psychotropic substances as if they were harmless.  Equally wrong is the use of several scales that were designed to measure outcomes of research studies but at some point psychiatrists and psychologist started to disseminate the idea that those instruments had diagnostic power.  These days you can hear a mother saying “how can you tell me that my son does not have ADHD when he has been tested multiple times by teachers and other doctors”?  

Also hard to understand is the complete disregard for the genetic endowments of patients.  A family history of hypertension, diabetes and cancer is considered relevant by every doctor but in psychiatry “it does not apply”.  I have seen the son of a bipolar mother and a schizophrenic father diagnosed with ADHD, ODD and Conduct Disorder (I call this the “evil triad”) and yet they don’t improve “despite adequate treatments”.

I think our profession stigmatizes certain illnesses, and celebrates others.  Take bipolar illness: 18 years ago, I diagnosed the first preschooler with bipolar disorder (both parents had it), and now such diagnosis would be highly criticized.   In contrast, look at ADHD:  Two decades ago, ADHD was limited to children in most cases, but now  it is diagnosed routinely in adults, and DSM-5 has given its stamp of approval.  Why these opposite attitudes?  It’s not because the scientific evidence supports such contrasts in our professional views.  There are reasonable studies to support the diagnosis of bipolar illness in children, and, as reviewed in PL, good reasons to doubt the limited studies which claim validity for adult ADHD.

Hopefully the organizations that represent the psychiatric community will take a responsible role in disseminating the truth about the exaggerated statistics of ADHD. When 90% or more of the patients in a doctor’s practice have the same diagnosis the validity of those diagnoses should be questioned.

PL comment:

PL thanks Dr. Mota-Castillo for these thoughts, bound to provoke some readers to agreement and others to dissent.  PL notes that Dr. Mota-Castillo has worked for two decades as a child and adult psychiatrist.  What PL would add is that his comments provide a perspective from within child psychiatric practice that is not represented often in professional publications. In his experience, ADHD is increasingly diagnosed within the profession, without much criticism, whereas the slightest increase in bipolar diagnosis, whether in children or adults, is met with strong reaction. He raises the question why this might be the case, from a professional and cultural perspective, and argues that such opinions are not based on purely scientific considerations. PL agrees that these are good questions for further discussion and consideration.  

PL Reflection

To say the truth, every physician almost hath his favourite disease, to which he ascribes all the victories obtained over human nature.  

Henry Fielding, 1749

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